Five Questions: Neurologist Charles H. Adler on the yips

Bernhard Langer of Germany hits an approach shot during a practice round prior to the start of the 2012 Masters Tournament at Augusta National Golf Club on April 2, 2012, in Augusta, Ga.

Bernhard Langer of Germany hits an approach shot during a practice round prior to the start of the 2012 Masters Tournament at Augusta National Golf Club on April 2, 2012, in Augusta, Ga. (Streeter Lecka, Getty Images)

The golf course is in pristine condition, there's nary a breeze, and you're about to sink a birdie on the 18th green. But just as the putter is about to meet the ball, your wrist jerks involuntarily — sending your round white nemesis 3 inches too far to the left.

Known as "the yips," this infuriating twitch has caused many a golfer to increase what would otherwise have been a perfectly respectable handicap. To the untrained eye, it looks like a clear-cut case of nerves kicking in at a crucial moment. But the way Mayo Clinic neurologist Charles H. Adler sees it, the yips might not be psychological at all; in fact, they may have their roots in the nervous system.

Among the afflicted are golf legends Ben Hogan and Sam Snead, as well as Tom Watson and Bernhard Langer, who are competing this week in the 2012 Masters Tournament at Augusta National. Adler, who works at Mayo'sParkinson's Disease and Movement Disorders Center in Scottsdale, Ariz., explained why he thinks researchers are getting closer to finding a cure.

The yips is a term used by golfers to describe an involuntary movement — a twist, a jerk or a shake — that usually happens when putting, although some people will describe it when doing other activities like chipping.

What makes you think there's more to this than golfers choking at a crucial moment?

There are a number of people who have a neurological illness called dystonia, which can cause cramps or pulling in the fingers or wrist while doing a specific task. It's known to occur in writers and musicians — in many cases the only time that they have a problem is when they are trying to perform a task related to their writing or music. In between they are completely normal.

We're trying to determine if there are some golfers who have a golfer's cramp that would be equitable to writer's or musician's cramps. With dystonia there is no diagnostic test, so what we're doing is pattern recognition. We found that there are some individuals who complain of the yips and have a twitch or a movement at the time of making the putt. We're trying to narrow down the pool of golfers that may have a neurological disorder so we can do further studies.

Is it worse for the pros, who play on TV and have serious prize money at stake?

Stress and anxiety make all movement disorders worse, so when somebody with a tremor of the hand, for instance, gets stressed or anxious, the tremor gets worse. A lot of people say the yips come out during tournaments, but that doesn't mean it's all psychological; it means that with stress, the movement disorder gets worse.

Could there be a cure someday?

If someone has a psychological cause to their yip, different treatments may be beneficial versus if someone has a neurological disorder.

There are a number of interventions we could look at. One would be just changing how a golfer holds the golf club. Changing the type of club may change how movement occurs too. There is a potential that some sort of pill might be beneficial since this might be neurological, or for botulinum injections to be helpful — in writer's or musician's cramp, it weakens the muscles that are cramping.

Some people use playing a round of golf as an excuse to have a few beers. Do the yips get better or worse with alcohol?

Alcohol is a relaxant, and it's very clear that some people with movement disorders can get some relief that way. The problem with alcohol is that over the years, tremor can get worse if people use alcohol to treat it. Because of its ill effects, it certainly would not be a recommended treatment.

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